Drug Coverage

The switch to biosimilars helped Navitus clients offset increased utilization in the non-specialty category and the introduction of higher-cost specialty drugs.

The FTC’s interim report on pharmacy benefit managers (PBMs) was just the latest effort to highlight what some say is an industry that profits at the expense of patients and independent pharmacists. The PBMs say the report paints an incomplete, misleading picture. Others say it shows the FTC is prepping its antitrust case.

The PBM industry said the FTC has not been objective, and that efforts to limit PBM negotiating tools would put patients at the mercy of drug manufacturers.

Company officials have said the bundled payment program could negatively impact sales of Xphozah, which was approved last year to reduce serum phosphorus in patients with kidney disease on dialysis.

The 3Axis Advisors analysis suggests PBMs’ spread pricing practices leads to employers being charged different amounts for the same medications and to pharmacists facing reimbursement challenges.

Nathan Downhour, Pharm.D., discusses the Pharmacy Match program, which will engage with physicians to make sure a specialty prescription gets to the best-fit pharmacy across a network powered by Free Market Health.

Included in this review will be 11 drugs that ICER assessed for cost-effectiveness in 2022. New this year is an assessment for consumer accessibility of drugs, including the burdens of prior authorization and patient cost-sharing measures.

Vanity Fair shines a light on how fake Ozempic and other semaglutide products have found their way into the U.S. supply chain.

LucyRx will begin providing pharmacy benefit services to self-insured employers, covering about half a million lives, beginning in January 2025.

In the United States, spending on oncology therapies rose to $99 billion in 2023, and is expected to grow to nearly $180 billion in 2028, finds a recent report by IQVIA Institute for Human Data Science.

The new program will launch in January 2025 and provide plan sponsors greater predictability of pharmacy spend.

Boehringer Ingelheim also received FDA approval for a high-concentration formulation of Cyltezo, its branded Humira biosimilar.

New KFF poll finds most of the adults who have taken GLP-1 therapies have diabetes or heart disease. But 38% said they have used for these drugs solely to lose weight.

If approved, abelacimab could yield cost savings in preventing stroke in patients with atrial fibrillation due to its ability to prevent bleeding.

Over the next five years, list prices of protected prescription drugs are expected grow between 1% and 4% a year, while net prices are expected to decline by the same amount, IQVIA predicts.

Specialty medications represent a large and growing proportion of overall drug spend, but plans and employers are struggling to understand their costs to make good decisions, finds the latest PSG Specialty Drug report.

The high-concentration biosimilar will be distributed under Quallent’s private label and will be available in June through Evernorth’s Accredo specialty pharmacy.

Zymfentra launched in March 2024 as the first subcutaneous formulation of infliximab for patients with ulcerative colitis and Crohn’s disease. It has a list price of $6,181.08 for two shots over four weeks.

Walgreens is expanding its specialty pharmacy services and renaming AllianceRx Walgreens Pharmacy as Walgreens Specialty Pharmacy.

Beginning in June 2024, Quallent Pharmaceuticals will provide Evernorth a high- and low-concentration interchangeable biosimilar of Humira.

New White Paper looks at the solutions and policy options of how to pay for high-cost gene therapies when there is still so much uncertainty about the outcomes and the durability of clinical benefits.

Researchers were unable to find a significant benefit for patients for the majority of cancer medications given accelerated FDA approval.

More than half of those survey by KFF who were disenrolled from Medicaid said they put off needed medical care because of costs.

Jeffrey Casberg, M.S., R.Ph., a senior vice president of clinical pharmacy at IPD Analytics LLC, a drug intelligence firm that advises payers and pharmaceutical companies, talks about how payers are thinking about weight-loss drugs.

Ventegra, which provides drug benefit solutions, is also converting to a nonprofit status, which will be completed June 30, 2024.

Caps on Medicare Part D cost sharing as a result of the Inflation Reduction Act, could reduce members’ financial incentive for switching to a biosimilar, suggests the newest Samsung Bioepis Quarterly Biosimilar Market Report.

Approved in late September 2022, Relyvrio will no longer be available for new amyotrophic lateral sclerosis (ALS) patients.

In 2025, the out-of-pocket cap and other Part D related provisions in the Inflation Reduction Act are projected to save women in Medicare an average of 28% in out-of-pocket costs, according to a new analysis from the Office of the Assistant Secretary for Planning and Evaluation.